Provider Demographics
NPI:1376567214
Name:ALVARADO, EUGENE O (OD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:O
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 SW MILITARY DR
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1407
Mailing Address - Country:US
Mailing Address - Phone:210-922-1163
Mailing Address - Fax:210-922-1776
Practice Address - Street 1:2310 SW MILITARY DR
Practice Address - Street 2:SUITE 501
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1407
Practice Address - Country:US
Practice Address - Phone:210-922-1163
Practice Address - Fax:210-922-1776
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6322T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1543191-02Medicaid
TX1543191-01Medicaid
TX1543191-01Medicaid
TX00617HMedicare PIN
TXU94113Medicare UPIN
TX5649700001Medicare NSC